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Thursday, May 15, 2014

WHO Says MERS Not Yet A Global Health Emergency

A newly-erected sign warns travelers about the danger of the MERS virus, at Denver International Airport, May 14, 2014 . MERS, or Middle East Respiratory Syndrome, is a respiratory illness that begins with flu-like fever and cough but can lead to shortness of breath, pneumonia and death. The airport says the signs were posted Wednesday, May 14, 2014 at all of its screening areas at the direction of the Centers for Disease Control. (Denver International Airport via AP)

A newly-erected sign warns travelers about the danger of the MERS virus, at Denver International Airport, May 14, 2014. (Denver International Airport via AP)

The World Health Organization says that MERS, the potentially fatal respiratory illness that originated in the Middle East, does not constitute a global health emergency — yet. But that does not mean that it’s not taking the disease seriously.

A map of countries with confirmed cases of MERS. (Centers for Disease Control)

Map via Centers for Disease Control

So far, MERS has been found in 18 countries, including two cases in the United States, and has killed 171 of the 571 people it has infected.

In the U.S., health care workers are being told to ask patients with respiratory symptoms and fever where they’ve traveled, and in some cases those patients are being isolated from others.

The outbreak of a previously unknown disease raises questions for travelers and health care workers and leaves many wondering whether they’re at risk of unintentional exposure.

For answers, Here & Now’s Sacha Pfeiffer turns to Dr. David Swerdlow, head of response activities for MERS at the Centers for Disease Control in Atlanta.


  • David Swerdlow, MD, head of response activities for MERS at the Centers for Disease Control.



The World Health Organization says that MERS, the often fatal respiratory illness that originated in the Middle East, does not constitute a global health emergency, but that doesn't mean the agency isn't taking this new disease seriously. So far, it's been found in 18 countries, including two cases in the U.S., and it's killed nearly a third of the roughly 570 people it's infected.

The outbreak has disproportionately affected health care workers, who have lived in or traveled to Saudi Arabia. But it also raises questions about who else is at risk, including travelers who may unknowingly be exposed to someone who's infected. For answers, we turn to Dr. David Swerdlow, who is leading the MERS response at the Centers for Disease Control in Atlanta.

And Dr. Swerdlow, let's start with the most basic question: What exactly is MERS, and what are its symptoms?

DAVID SWERDLOW: MERS is a virus that emerged in 2012. It's similar to the virus that caused SARS back in 2002. But it is different. It causes respiratory symptoms: fevers, chills, cough, sweats - similar to flu. But unfortunately, in a high proportion of people, it actually goes on to become pneumonia and can even lead to death.

One of the biggest problems with the MERS virus is that the fatality rate is extremely high, anywhere from 25 to 30 to 40 percent, and that's much higher than we see with other respiratory viruses.

PFEIFFER: What is typical treatment?

SWERDLOW: Unfortunately, there is no specific treatment or vaccine for MERS. Most people are treated supportively. They are put into an intensive care unit. They're treated with, you know, ventilators and that sort of treatment. But unfortunately, there is no specific treatment for MERS virus.

PFEIFFER: Based on what we've read, most of these cases are linked to countries in the Arabian Peninsula. Is that correct?

SWERDLOW: Yes, that's right. All the cases have had some connection the Arabian Peninsula, either from a person living there, or a traveler returning to another country, or in some cases, there was very limited spread to household members or other close contacts of the travelers in other countries.

PFEIFFER: So for people who are not health care workers, how close does contact have to be for us to begin worrying? So for people who want to reduce their exposure, what should they be cautious of?

SWERDLOW: Well, so far, most of the cases have been very close contacts, like family members. And so we think that it has to be close contact for prolonged period of time. However, we're not taking any chances, and that's why with the recent cases in the United States, we've followed up on people who even had minimal contact, like people on airplanes or people in waiting rooms of the emergency room, just to be sure because we don't want to take any chances, and this is out of an abundance of caution.

But most of the people who have gotten sick that we know about have had much more extensive contact.

PFEIFFER: You know, speaking of airplanes, we have read that one possible safety measure would be testing people's temperatures before they board a plane, since fever can be a gauge for someone who has MERS. And in fact the Secretary of Defense Chuck Hagel had to have an infrared temperature scan before he had a meeting with Saudi crown prince recently.

So in your view, should airlines be doing temperature testing, at least in some parts of the world for passengers?

SWERDLOW: The problem is that the number of people who would get on a plane with a fever or going across a border with a fever is huge. There are literally hundreds of things that cause fever in a patient. So if you tried to set up a screening program and didn't allow people into the country, for example, or on an airplane, you would have thousands and thousands and thousands of people who would be denied passage.

PFEIFFER: Then if fever testing may be too wide a net, what would your advice be, especially on travel to the Middle East given this health concern? Are there restrictions of precautions needed?

SWERDLOW: CDC does have a travel notice up. It's called a level two notice. And that says that people who are going to the Middle East who actually take care of patient or be in a health care setting should probably take precautions and take note of the risk of MERS. At this time we don't have any other specific recommendations.

PFEIFFER: If there is someone out there who suspects they may have been exposed, what should that person do?

SWERDLOW: If they're not having any symptoms, then they can just watch and see if anything develops, like a fever or chills or sweats. But if they have symptoms, they should call ahead to their doctor and let them know that they may have been exposed, and they are ill and then arrange to be seen by the doctor.

PFEIFFER: We read that just this week in Saudi Arabia, because the virus that causes MERS has been found in camels, that Saudi Arabia is advising people to avoid raw camel meat and unpasteurized camel milk. Any advice along those lines that would apply to the United States?

SWERDLOW: Well, there's no question that there have been multiple studies that have shown that camels carry this virus. And there's also no question that we have anecdotal reports of people who rode camels or came in contact with camels who became ill. So there is certainly some connection with camels.

There's been no study to specifically say what proportion of all MERS cases have had exposure to camels or what was the specific exposure. Was it kissing a camel, which people do, or just coming in contact with a camel or drinking camel milk?

So we don't know which one of those exposures is associated with the actual risk. But, you know, there's no question that at least some of the cases are associated with exposure to camels.

PFEIFFER: Dr. David Swerdlow is leading the response to the respiratory illness MERS for the Centers for Disease Control in Atlanta. Dr. Swerdlow, thank you.

SWERDLOW: Thank you very much.

PFEIFFER: You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.

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